Wednesday, August 08, 2007

Easy coverage extension possible

The Commonwealth Fund has just released a report that shows roughly 30% of all uninsured individuals are young adults between 19 and 29. Young people disproportionally lose coverage due to a combination of very low incomes, job transience, loss of coverage due to aging out of their parents' coverage and minimally rational calculations that since they are young and healthy they can afford to take more risks. (full brief here)

I have had periods without health insurance coverage due to a combination of all of these problems. When I graduated, I lost my parent's very good coverage, and my first job provided 'hit by the bus' coverage with only a 20% subsidy, so it really was not any coverage. After I got laid off last year, COBRAing my coverage forward would have taken roughly 50% of my unemployment monthly income, so that was not an option. I was able to find a cheap catastrophic coverage plan for the 'hit by the bus' scenario, but again, I was effectively without coverage for the first $20,000 in bills. Thankfully I was and am pretty damn healthy at this point in my life.

And fortunately from a policy perspective, most young adults are pretty damn healthy at this point in their lives, so coverage is pretty cheap. If one wants to implement over the long term, single payer, multiple provider health care, incrementalism as the fallback position from sweeping overhauls is not a bad way to move forward. Covering children in SCHIP and then expanding SCHIP with a very cheap buy-in option for young adults is a nifty way to increase preventative care, decrease labor market barriers of entry for young adults, and continue to build a political constiuency for universal health coverage. Combine this track with allowing earlier and earlier buy-ins into Medicare and squeeze the demographic middle.

But I am thinking too far ahead right now --- young adults are statistically pretty cheap to cover, and the costs of non-coverage both socially and personally are pretty high, so I think this is something that we change, and it is something that I am willing to pay more in taxes to support.